Longitudinal Predictors of Informant-Rated Everyday Function in Mild Cognitive Impairment.

OBJECTIVE: To examine predictors of informant-reported everyday functioning in mild cognitive impairment (MCI) and relations between everyday function and conversion to dementia. METHODS: Informants of participants (n = 2614) with mild cognitive impairment (MCI) were administered the Functional Activities Questionnaire (FAQ). Changes in dimensions of functional ability as determined by an exploratory factor analysis (EFA) were examined over 3 years and participant predictors of change were examined using multilevel modeling (MLM). RESULTS: The FAQ consisted of 3 factors, multistep, finance, and memory/orientation daily tasks. Impairment in memory/orientation tasks was significantly higher than impairment in multistep tasks. Worse functioning was associated with greater depression, worse memory, worse speed/EF, higher years of education and identifying as White. There was variability in some of these associations with different FAQ factors. Impairments in financial and memory/orientation daily tasks predicted follow-up conversion to dementia. CONCLUSIONS: Depression, speed/EF, and memory are consistently associated with domains of everyday functioning. Race, education, and age may be more variability associated with everyday functioning. Specific attention should be paid to subtle declines in the financial and memory/orientation domains as they may uniquely predict future dementia development. Depression may be a modifiable risk factor associated with functional impairment over time.

Resilience as a moderator of depression and anxiety: a bidimensional approach to predictors of subjective cognition in older adults.

OBJECTIVES: Subjective cognitive complaints (SCCs) have shown to be useful predictors of objective cognitive decline in older adults. Though psychopathology symptoms (e.g. depression, anxiety) have been linked to SCCs, little is known about the influence of positive psychology factors (e.g. resilience) on these complaints. The current study aimed to determine whether resilience predicts SCCs, and whether greater resilience moderates (or lessens) the effect of negative mental health symptoms on SCCs. METHODS: Four hundred twenty-eight adults aged 60 years or older (M = 67.6, SD = 5.9) were recruited to participate in an online Qualtrics survey study. Surveys included assessed psychological resilience [University of Washington Resilience Scale 8-item short form (UWRS-8)], depression [Geriatric Depression Scale (GDS-15)], anxiety [Geriatric Anxiety Scale (GAS-30)], and SCCs [Perceived Deficits Questionnaire-Depression (PDQ-D); Barkley Deficits in Executive Functioning Scale-Short Form (BDEFS-SF)]. RESULTS: Although greater resilience was only independently associated with less complaints on BDEFS total scores, resilience moderated (i.e. reduced) the negative effects of depression and anxiety on PDQ-D retrospective memory and planning subscales as well as BDEFS-SF total scores. Resilience also moderated (i.e. reduced) the negative effect of anxiety on PDQ-D total scores. CONCLUSION: With resilience lessening the effect of depression and anxiety on SCCS, our findings suggest positive psychological factors may be useful for understanding the prevalence of complaints. Future research should seek to replicate these findings and investigate relationships between additional positive psychological factors and cognitive health in old age including the use of both objective and subjective assessments of cognition.

Longitudinal assessment of mental health after a flood: roles of social support, hope, recovery stressors, and prior lifetime trauma.

OBJECTIVES: Severe weather events have mental health consequences for survivors that may change over time. We assessed post-flood mental health longitudinally in three groups of mostly middle-aged and older adults who varied in current and prior severe weather experiences. METHOD: Predictors of central interest were age, perceived social support, state hope (including agency and pathways), recovery stressors, and prior lifetime trauma. Criterion variables included symptoms of depression, post-traumatic stress disorder (PTSD), and worry. RESULTS: Analyses of variance yielded significant Disaster Exposure Group x Wave interactions for depression and PTSD symptoms. Those with flooded homes and properties had elevated symptoms at Wave 1 which were reduced at Wave 2. Older age was associated with fewer symptoms of depression, PTSD, and worry. Recovery stressors and lifetime trauma predicted more PTSD symptoms. Greater agency predicted less PTSD and depression symptoms, whereas pathways predicted less worry. CONCLUSION: These data show that mental health symptoms may decrease over time for those directly impacted by severe flooding. State hope appears to contribute to better mental health after exposure to a devastating flood. Implications for understanding the dynamic relationships among risk variables and positive factors that promote post-disaster mental health in the years after a flood are considered.

Value-consistent rehabilitation is associated with long-term psychological flexibility and quality of life after traumatic brain injury.

Meaningful steps have been taken toward using holistic approaches in outpatient rehabilitation for traumatic brain injury (TBI) (i.e., treating the whole individual); however, research and practice continue to disproportionately focus on adapting to physical and cognitive changes. Research suggests treatment focusing on individual values may be important for psychological adjustment after TBI. The current study sought to explore individual values across multiple life domains in those with TBI as well as what values outpatient rehabilitation was helpful for, and to examine discrepancies between these factors (i.e., value-consistent rehabilitation) in relation to important long-term treatment outcomes. 215 adults with a history of TBI who had participated in outpatient rehabilitation completed online surveys assessing how consistent outpatient rehabilitation was with individual values, psychological flexibility, and quality of life. The life domains with the greatest discrepancies between individual importance and rehabilitation helpfulness were spirituality, intimate relations, and family relations. Greater value-consistent rehabilitation was associated with higher levels of psychological flexibility and quality of life beyond demographics and injury characteristics. Our findings provide further support in favour of holistic, client-centred approaches that are facilitated by neurological rehabilitation programs.

Religiosity and Social Support Predict Resilience in Older Adults After a Flood.

In this study, we examined religiosity and social support as predictors of resilience after a devastating flood. Three flood exposure groups of primarily middle-aged and older adults were compared: (1) non-flooded adults as controls, (2) once-flooded adults with structural damage to homes and property in the 2016 flood, and (3) twice-flooded adults who had relocated inland because of prior catastrophic losses in the 2005 Hurricanes Katrina and Rita and then flooded again in 2016. Resilience was assessed using the Connor-Davidson Resilience Scale (CD-RISC). Correlation analyses confirmed that older age was correlated with higher religiosity, charitable work done for others, and resilience. Regression analyses indicated that religious beliefs and coping, social support, and charitable work done for others were associated with higher levels of resilience, whereas flood damage was unrelated to resilience. Implications for current views on post-disaster adversity and resilience in later life are discussed.

Beliefs, Understanding, and Barriers Related to Dementia Research Participation Among Older African Americans.

BACKGROUND: United States Census Bureau projects African Americans (AAs) will be one of the fastest growing populations over the next 30 years. Research suggests they are at higher risk for developing dementia. It is important to know about AA adults' beliefs about, and knowledge of, dementia; and how these beliefs and knowledge impact participation in dementia research. METHODS: Four focus groups were completed with 51 older AA adults (76.5% female; mean age=68) in Baton Rouge, Louisiana to examine understanding of dementia and barriers influencing willingness to participate in a clinical trial on dementia risk reduction. FINDINGS: Participants exhibited awareness of several risk and protective factors related to dementia, including family history of dementia, lack of cognitive engagement, and sedentary lifestyles. They were willing to participate in interventions to lower the risk of developing dementia. Barriers to participation included invasive procedures, pharmaceutical interventions, mistrust of investigators, inadequate compensation, and long study duration. DISCUSSION: Given the high relevance of dementia research to older AAs, their knowledge of dementia, and their willingness to participate in dementia research once barriers are addressed, it is imperative to continue to identify and remediate factors contributing to the poor representation of AAs in dementia research.

Beyond depression: examining the role of anxiety and anxiety sensitivity on subjective cognition and functioning in older adults.

OBJECTIVES: Subjective cognitive difficulties in the elderly may serve as potential risk-factors for future, objective decline and conversion to neurodegenerative disorders (e.g., mild cognitive impairment [MCI] and dementia). Though these subjective declines have been associated with depression, and to a lesser extent, anxiety, it is unknown if related constructs (e.g. anxiety sensitivity) and specific kinds of worries (e.g. worry about developing dementia, health anxiety) are related to subjective declines. The current study sought to examine if cognitive concerns related to anxiety sensitivity, dementia worry, and health anxiety added incremental validity beyond general symptoms of anxiety and depression in predicting subjective cognition and functioning in a sample of older adults. METHODS: Participants were 429 older adults who were at least 60 years old. Participants completed questionnaires on subjective cognition, subjective everyday function, anxiety, depression, anxiety sensitivity, dementia worry, and health anxiety via Qualtrics Panels. Hierarchical multiple regressions were conducted. RESULTS: Our variables of interest (anxiety sensitivity, dementia worry, and health anxiety) added significant variance in predicting subjective cognition and everyday function. Specifically, anxiety sensitivity was related to subjective cognition and functioning, while dementia worry and health anxiety were variably associated. CONCLUSION: Our results suggest that constructs related to anxiety and worry have a significant relationship with subjective cognition and function in older adults beyond general symptoms of depression and anxiety. Future work should examine if interventions and education may help to decrease anxiety sensitivity and worry about dementia respectively in older adults, which may in tern protect against future subjective declines.

Psychometric properties of the interpersonal needs questionnaire (INQ-15) in Army soldiers: Implications and future directions.

The Interpersonal Theory of Suicide posits that two unmet interpersonal needs, thwarted belongingness and perceived burdensomeness, interact to predict suicide desire. These two constructs are frequently assessed using the 15-item Interpersonal Needs Questionnaire (INQ-15); however, this measure has never been validated in military service members. The current study analyzed the psychometric properties of the INQ-15 in a sample of (N = 1096) military personnel stationed overseas. Results indicated that the two-factor model of the INQ-15 had a poor model fit in this population; however, a bifactor model with two specific factors representing TB and PB demonstrated good fit. As seen in previous research, perceived burdensomeness was more strongly related to suicidal ideation severity than thwarted belongingness. Implications and future directions for research are discussed.

Social factors that predict cognitive decline in older African American adults.

OBJECTIVES: Projections from the United States Census Bureau suggest that the African American population may be the fastest growing race over the next 30 years and that they may be at the highest risk for developing dementia later in life. Various social factors have been shown to be associated with cognitive function and health outcomes. The present study aims to evaluate the relationship between social engagement and cognitive decline in a cohort of older African American adults. METHODS: We utilized multilevel modeling to examine the association between cognitive decline and social engagement in a sample of 617 older African American adults. RESULTS: Social activity was associated with global cognition, perceptual speed, perceptual orientation, and episodic memory over time. Loneliness was associated with better semantic memory performance over time. Perceived discrimination was associated with better semantic memory performance over time. Larger social network was associated with worse perceptual speed scores over time. CONCLUSIONS: Although our findings on loneliness and perceived discrimination over time were inconsistent with prior research, our findings on social activity and social network size over time were consistent with past literature and are thought to be due to positive social interactions providing a catalyst for cognitively stimulating activities. These results suggest that interventions designed to preserve cognition in African American older adults should incorporate adequate social activity. Furthermore, to maximize effectiveness, interventions should not necessarily focus on just expanding one's social network.

Examining Relationships between Multiple Self-Reported Sleep Measures and Gait Domains in Cognitively Healthy Older Adults.

BACKGROUND: Gait-related changes in older adulthood may be related to changes in cognition (e.g., executive functioning), and recent work suggests that different self-reported measures of sleep may be tied to contrasting aspects of executive functioning. However, the relationship between these self-reported sleep measures and gait domains has not been explored. Such an investigation would be useful in helping to determine which older adults might exhibit changes in gait as well as experience other gait-associated changes (e.g., increased fall risk). OBJECTIVE: To examine associations between different aspects of self-reported sleep and gait domains in a sample of cognitively healthy older adults. METHOD: A total of 423 older adults (mean age 69.9 years, range 50-92) completed self-report measures of sleep quality, daytime sleepiness, and sleep-related distress. The participants also completed an objective, electronic measure of both single-task and dual-task gait (i.e., GAITRite). Principal component analyses were used to elucidate the solution for each gait condition, and multiple linear regression was used to examine the contributions of sleep measures to variability in gait performance. RESULTS: A 5-component solution of the single-task condition and a 4-component solution of the dual-task condition were identified. Multiple linear regressions revealed that a poorer sleep quality was associated with greater single-task and dual-task asymmetry. Greater daytime sleepiness was associated with increased dual-task gait variability and postural control. After controlling for the effects of other facets of sleep, sleep-related distress was not associated with any gait domain. CONCLUSIONS: Among cognitively healthy older adults,sleep quality and daytime sleepiness, but not sleep-related distress, are associated with aspects of gait. Patients who report these symptoms should be assessed and monitored for possible changes in gait.

Assessment of anxiety in older adults: psychometric properties and relationships with self-reported functional impairment.

OBJECTIVE: The current study aimed to examine the psychometric properties of two geriatric anxiety measures: the Geriatric Anxiety Inventory (GAI) and the Geriatric Anxiety Scale (GAS). This study also aimed to determine the relationships of these measures with two measures of functional ability and impairment: the Barkley Functional Impairment Scale (BFIS) and the Everyday Cognition Scale (E-Cog). DESIGN: Confirmatory factor analyses (CFA) were used to analyze the factor structures of the GAI and GAS in older adults. Tests for dependent correlations were used to examine the relationship between anxiety scales and functioning. SETTING: Amazon's Mechanical Turk. PARTICIPANTS: 348 participants (aged 55-85, M= 62.75 (4.8), 66.5% female) with no history of psychosis or traumatic brain injury. RESULTS: CFAs supported the previously demonstrated bifactor solution for the GAI. For the GAS, the previously demonstrated three-factor model demonstrated a good-to-excellent fit. Given the high correlation between the cognitive and affective factors (r =.89), a bifactor solution was also tested. The bifactor model of the GAS was found to be primarily unidimensional. Tests for dependent correlations revealed that the GAS demonstrated stronger relationships with measures of self-reported functional impairment than the GAI. CONCLUSIONS: The current study provides further psychometric validation of the factor structure of two geriatric anxiety measures in an older adult sample. The results support previous work completed on the GAI and the GAS. The GAS was more strongly correlated with self-reported functional impairment than the GAI, which may reflect differences in content in the two measures.

Psychometric properties of the expanded version of the inventory of depression and anxiety symptoms (IDAS-II) in a sample of older adults.

Objective: Given the strong relationship often found between self-report measures of anxiety and depression, the Inventory of Depression and Anxiety Symptoms (IDAS) was created and then expanded (IDAS-II) to assess common and unique symptom dimensions of these emotional disorders. Limited research has focused on the use of the IDAS-II with older adults and the purpose of the current study was to provide data on the reliability and validity of the IDAS-II in this population.Method: A sample of 323 participants (age 55-80 years) were recruited online using Amazon's Mechanical Turk (MTurk). They completed the IDAS-II and several other self-report questionnaires of internalizing symptoms, including widely used measures developed specifically for older adults. Internal consistency and validity of the IDAS-II were examined.Results: The IDAS-II demonstrated marginal to excellent internal consistency (α = .68-.91). An exploratory factor analysis indicated three factors: Distress, Positive Mood, and Obsessions. The IDAS-II explained a large amount of variance in the other measures of depression and anxiety (ranging from 52% to 76%) and the IDAS-II Dysphoria scale significantly related to all of the other measures of depression and anxiety (ranging from r = .69 to r = .81).Conclusion: These results support the use of the IDAS-II with older adults as it has good convergent validity with other commonly used measures of depression and anxiety, including those commonly used in the assessment of older adults. Further research can use the IDAS-II with both younger and older adults to examine age-related changes in depression and anxiety symptoms.

Predictors of Collegiate Student-Athletes' Concussion-Related Knowledge and Behaviors.

OBJECTIVE: This study aimed to explore student-athletes' concussion-related knowledge and attitudes toward reporting symptoms, demographic predictors of knowledge and attitudes, and determine whether responses to the survey changed following an online educational intervention. METHODS: A total of 108 Division I student-athletes enrolled at a large southern university completed a survey evaluating knowledge regarding concussion-related terminology, symptoms and recovery trajectories, as well as attitudes toward reporting symptoms following a possible concussion. Student-athletes completed the questionnaire both 24-48 h before and one week after reviewing the educational presentation. RESULTS: At baseline, participants correctly identified 72% of concussion symptoms included in the questionnaire, as well as correctly identified 75% of items related to the typical recovery trajectory post-concussion. A total of 54% of baseline attitudes toward reporting symptoms matched clinical best practices. Multiple analysis of variance (MANOVA) revealed that male sex and non-Caucasian race were associated with worse baseline knowledge of concussion symptoms. Concussion knowledge was not associated with attitudes toward reporting symptoms. Paired samples t-tests indicated that knowledge of concussion-related terminology improved modestly following the educational presentation. CONCLUSIONS: Some subsets of collegiate student-athletes show relatively lower knowledge about symptoms of concussion than others. As a result, these groups may benefit from increased educational efforts to ensure they recognize when a concussion may have occurred. Additionally, as knowledge and attitudes were unrelated and the intervention had a modest effect on knowledge but not attitudes, future work should explore interventions that are designed to directly alter attitudes.

Prédicteurs des connaissances et des comportements d'athlètes-étudiants post-secondaires en ce qui regarde les commotions cérébrales. Objectif: Cette étude vise à explorer les connaissances et les attitudes d'athlètes-étudiants en ce qui regarde le signalement des symptômes liés aux commotions cérébrales mais aussi les prédicteurs démographiques de ces connaissances et de ces attitudes. Elle vise également à déterminer dans quelle mesure des réponses à un sondage ont changé à la suite d'une intervention éducative en ligne. Méthodes: Un total de 108 athlètes-étudiants de première division inscrits dans une université importante du sud des États-Unis ont ainsi répondu à un sondage visant à évaluer, outre leurs attitudes à l'égard du fait de signaler des symptômes consécutifs à une possible commotion cérébrale, leurs connaissances en ce qui regarde la terminologie des commotions cérébrales, les symptômes qui y sont liés ainsi que les trajectoires de rétablissement. Fait à souligner, ces jeunes ont complété le sondage 24 à 48 heures avant leur présentation éducative en ligne et une semaine après l'avoir visionnée. Résultats: Au départ, nos répondants ont correctement identifié 72 % des symptômes de commotion cérébrale inclus dans le sondage. Ils ont aussi identifié correctement 75 % des aspects liés à une trajectoire de rétablissement typique suivant une commotion cérébrale. Un total de 54 % d'attitudes au départ à l'égard du fait de signaler des symptômes a correspondu aux meilleures pratiques sur le plan clinique. Une analyse de variance multivariée (ou « MANOVA ¼ en anglais) a par ailleurs révélé que les athlètes masculins non-caucasiens étaient associés à de plus faibles connaissances de départ au sujet des symptômes des commotions cérébrales. Le fait de posséder de telles connaissances n'a pas été associée à des attitudes spécifiques en ce qui a trait au signalement de symptômes. Des tests de Student d'échantillons appariés ont indiqué que les connaissances portant sur la terminologie des commotions cérébrales se sont améliorées légèrement à la suite des présentations éducatives. Conclusions: Quelques sous-groupes d'athlètes-étudiants du collège ont montré des connaissances relativement plus faibles au sujet des symptômes liés aux commotions cérébrales si on les compare à d'autres. En cela, il se pourrait qu'ils puissent bénéficier d'efforts éducatifs accrus nous permettant de nous assurer qu'ils sont en mesure de reconnaître lorsqu'une commotion éventuelle s'est produite. De plus, considérant que connaissances et attitudes ne sont pas reliées et que l'intervention en ligne a eu un faible impact sur les connaissances mais non sur les attitudes, les efforts à venir devraient envisager des interventions destinées directement à modifier ces mêmes attitudes.

Examining differences in neuropsychiatric symptom factor trajectories in empirically derived mild cognitive impairment subtypes.

OBJECTIVE: The aim of this study was to examine neuropsychiatric symptom (NPS) factor severity progression over time in empirically derived (ED) mild cognitive impairment (MCI) subtypes. METHODS: Participants in the Alzheimer's Disease Neuroimaging Initiative study diagnosed with MCI by Alzheimer's Disease Neuroimaging Initiative protocol using conventional clinical (CC) criteria (n = 788) were reclassified using cluster analysis as amnestic, dysnomic, dysexecutive MCI, or cluster-derived normal (CC-Normal) using empirical criteria. Cognitively normal (CN) participants (n = 207) were also identified. The Neuropsychiatric Inventory-Questionnaire (NPI-Q) was administered from baseline through 48-month follow-up. Exploratory factor analysis was completed to determine the NPI-Q factor structure at 6-month follow-up. Multilevel modeling was used to determine NPI-Q symptom severity factor and apathy symptom progression over time by cognitive subtype. RESULTS: The exploratory factor analysis revealed that the NPI-Q consisted of 2 factors: hyperactivity/agitation and mood symptoms. Using clinical and empirical criteria, all MCI groups were identified as having more severe hyperactivity/agitation symptoms than CN participants. However, only the amnestic MCI group identified using empirical criteria showed an increase in symptom severity over time relative to CN participants. Mood factor and apathy symptoms were found to be more severe in dysexecutive and amnestic groups in both models. Similarly, both models identified a significant worsening of mood and apathy symptoms over time for dysexecutive and amnestic groups relative to CN participants. CONCLUSIONS: This study provides further support that empirical criteria aid in examining the progression of clinical characteristics associated with MCI. Further, it helps to identify which MCI subtypes may be at higher risk for NPS progression.

The Knowledge of Memory Aging Questionnaire: Factor Structure and Correlates in a Lifespan Sample.

The authors examined the factor structure of the Knowledge of Memory Aging Questionnaire (KMAQ) [1] using confirmatory factor analysis in a lifespan sample of 933 individuals who ranged in age from 18 to 101. Participants were college students at Louisiana State University and adults from the community enrolled in the Louisiana Healthy Aging Study (LHAS). A two-factor solution was expected, consistent with the normal and pathological memory aging dimensions that comprise the KMAQ. A bi-factor solution with items loading on a general response bias factor and either a normal or pathological knowledge-specific factor showed good model fit. Knowledge scores were correlated with demographic and cognitive performance variables. Implications of these data for clinical settings and research are considered.

Lesion mapping of cognitive control and value-based decision making in the prefrontal cortex.

A considerable body of previous research on the prefrontal cortex (PFC) has helped characterize the regional specificity of various cognitive functions, such as cognitive control and decision making. Here we provide definitive findings on this topic, using a neuropsychological approach that takes advantage of a unique dataset accrued over several decades. We applied voxel-based lesion-symptom mapping in 344 individuals with focal lesions (165 involving the PFC) who had been tested on a comprehensive battery of neuropsychological tasks. Two distinct functional-anatomical networks were revealed within the PFC: one associated with cognitive control (response inhibition, conflict monitoring, and switching), which included the dorsolateral prefrontal cortex and anterior cingulate cortex and a second associated with value-based decision-making, which included the orbitofrontal, ventromedial, and frontopolar cortex. Furthermore, cognitive control tasks shared a common performance factor related to set shifting that was linked to the rostral anterior cingulate cortex. By contrast, regions in the ventral PFC were required for decision-making. These findings provide detailed causal evidence for a remarkable functional-anatomical specificity in the human PFC.

Neuroanatomical correlates of executive functions: a neuropsychological approach using the EXAMINER battery.

Executive functions (EF) encompass a variety of higher-order capacities such as judgment, planning, decision-making, response monitoring, insight, and self-regulation. Measuring such abilities quantitatively and establishing their neural correlates has proven to be challenging. Here, using a lesion-deficit approach, we report the neural correlates of a variety of EF tests that were developed under the auspices of the NINDS-supported EXAMINER project (Kramer, 2011; www.examiner.ucsf.edu). We administered a diverse set of EF tasks that tap three general domains--cognitive, social/emotional, and insight--to 37 patients with focal lesions to the frontal lobes, and 25 patients with lesions outside the frontal lobes. Using voxel-based lesion-symptom mapping (VLSM), we found that damage to the ventromedial prefrontal cortex (vmPFC) was predominately associated with deficits in social/emotional aspects of EF, while damage to dorsolateral prefrontal cortex (dlPFC) and anterior cingulate was predominately associated with deficits in cognitive aspects of EF. Evidence for an important role of some non-frontal regions (e.g., the temporal poles) in some aspects of EF was also found. The results provide further evidence for the neural basis of EF, and extend previous findings of the dissociation between the roles of the ventromedial and dorsolateral prefrontal sectors in organizing, implementing, and monitoring goal-directed behavior.

A survey of the perceptions and practices of faculty in clinical neuropsychology doctoral training programs: is heterogeneity the norm?

Objective: Doctoral education is a cornerstone in the training of clinical neuropsychologists. However, we know little about perceptions, practices, and needs of the faculty who oversee doctoral training in clinical neuropsychology (CN). Method: Seventy-one faculty from 45 doctoral programs providing CN training completed at least part of a survey assessing characteristics of their programs, current training practices and views, and challenges to CN doctoral training. Results: Over half of CN faculty reported having zero or only one CN colleague. CN faculty reported that the goals of CN doctoral training are research training, clinical training, and acquisition of knowledge and skills reflected in the Houston Conference Guidelines (HCG). CN faculty reported that doctoral trainees obtain more clinical hours than faculty would like and endorsed alternative clinical metrics, including competency-based ratings. CN faculty are divided about the benefits of a required two-year postdoctoral CN fellowship. Conclusions: The HCG states that specialization in CN begins at the doctoral level. CN faculty in doctoral programs are fully immersed in the early development and education of future CN researchers and practitioners. Tensions between clinical and research training in CN at the doctoral level-and student overemphasis on accruing clinical hours-might place CN at risk for failing to make research innovations necessary for our field to evolve and thrive. More CN doctoral faculty are needed to serve as mentors to students, especially for students from backgrounds that have been historically excluded and marginalized. A greater voice from CN doctoral faculty in CN governance is needed.

Factor Structure and Measurement Invariance of the Suicide Status Form-IV.

The Suicide Status Form-IV (SSF-IV) is the measure used in the Collaborative Assessment and Management of Suicidality (CAMS). The SSF-IV Core Assessment measures various domains of suicide risk. Previous studies established a two-factor solution in small, homogeneous samples; no investigations have assessed measurement invariance. The current investigation sought to replicate previous factor analyses and used measurement invariance to identify differences in the Core Assessment by race and gender. Adults (N = 731) were referred for a CAMS consultation after exhibiting risk for suicide. Confirmatory factor analyses indicated good fit for both one- and two-factor solutions while the two-factor solution is potentially redundant. Configural, metric, and scalar invariance held across race and gender. Ordinal logistic regression models indicated that neither race nor gender significantly moderated the relationship between the Core Assessment total score and clinical outcomes. Findings support a measurement invariant, one-factor solution for the SSF-IV Core Assessment.

The structure of apathy symptoms.

INTRODUCTION: Apathy is common in many neurological, psychiatric, and medical disorders and is related to a number of important clinical outcomes. Nonetheless, research on apathy is hindered by different ways of defining and measuring it, which has led to heterogeneity in research findings. METHOD: The current study aimed to investigate the factor structure of apathy symptoms using a novel item pool. We examined whether the use of this item pool has incremental validity above and beyond a widely used measure in predicting cognition and everyday functioning. Participants included 249 informants who reported on an individual with (n = 210) or without (n = 39) a neurological or psychiatric condition. RESULTS: Results showed the best fitting model of apathy symptoms was a bifactor model with apathy as a general dimension and three specific symptom factors including reduced interest and initiative, reduced emotional and verbal expression, and reduced social engagement. Incremental validity in predicting cognition was demonstrated for this more robust assessment of apathy symptoms. CONCLUSIONS: Results are most aligned with one set of proposed diagnostic criteria for apathy which differs from other criteria in that it does not distinguish between cognitive and behavioral symptoms and includes a separate social dimension. Future research could aim to replicate this model in additional clinical samples and explore the incremental validity of the newly developed Apathy Symptom Inventory (ASI) in comparison to other recently developed measures.